Marseille 2007
| Abstract #452 - Integration of IFC into PMTCT/ MCH services: Implications on quality of care | ||||
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Session: 17.5: Challenges for Children (Parallel) on Monday @ 14.00-16.00 in Auditorium/Overflow Chaired by Patrice Engle, Christina Noestlinger Authors: Presenting Author: Dr Jane Julie Murugi - University of Nairobi / NARESA, Kenya |
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| Additional Authors: | ||||
| Aim: To describe the quality of infant feeding counseling (IFC) at facilities offering integrated PMTCT/MCH services, in Nairobi, Kenya. | ||||
| Method / Issue: STUDY DESIGN: Cross-sectional study conducted in 2005, at 3 randomly selected PMTCT scale-up sites; one tertiary and two primary health care (health centre) sites. Participants included health workers, antenatal and postnatal (< 7 months postpartum) clients. Selection was random and purposive for quantitative and qualitative interviews, respectively. All requisite ethical procedures were followed. DATA COLLECTION AND ANALYSIS: Quantitative data were collected using semi-structured questionnaires and analyzed using descriptive and analytical statistical methods (SPSS). Reported p values are two-sided, alpha level of 0.05. Qualitative data were analyzed manually along study themes. | ||||
| Results / Comments: STUDY RESULTS: 162 client-provider interactions were observed; 391 clients (24% HIV positive) and 26 health workers interviewed. Median infant age was 2.4 months (range 0.07 6.95 months). The quality of IFC practice was poor at all sites, although it was significantly better at KNH site. Almost half (45.4%) of the clients said the health worker had never discussed IF during all past MCH visits, and 49% said that the IFC received was inadequate to guide IF decisions. Health workers quoted work overload and low motivation as deterrents to quality IFC practice. Client knowledge on IF was inadequate at all sites. Higher client knowledge was independently associated with: KNH site (p=0.018, AOR 2.5, (95% CI 1.2 5.3)); health worker having discussed IF more than thrice during past visits (p=0.001, AOR 4.1, (95% CI 1.7 9.5)); and health worker having discussed six to ten key breast-feeding messages during past visits (p<0.001, AOR 17.6, (95% CI 17.3 42.7)). Client infant feeding practice (IFP) was sub-optimal at all sites. High rates (43%) of mixed feeding were reported. KNH site was the only factor independently associated with optimal IFP (p=0.014, AOR 3.2, (95% CI 1.3 8.0)). Optimal IFP was unrelated to client HIV status, level of education, occupation, or place of delivery. | ||||
| Discussion: DISCUSSION: The quality IFC at sites integrating IFC into routine PMTCT/MCH care was poor, chiefly due to work overload and low staff motivation. Poor IFC could have contributed to the inadequate client knowledge on infant feeding and the sub-optimal IFP found in this study. Better IFC, client knowledge and IFP at KNH site could be attributable to it being a tertiary care facility endowed with more health workers of more specialized cadre. Findings raise significant concern on the extent to which infant survival is being safeguarded at PMTCT scale up sites. Key recommendations are that IFC should be prioritized and mainstreamed into routine MCH care at PMTCT sites. And, to circumvent the challenge of work overload, use of innovative lay-counselor IFC approaches should be explored. | ||||
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